Why the TAKING ACTION Framework is needed

06 October 2016

For the first time, a guide to improved claims management for mental-illness related claims and a determination of best practice principles is provided by TAKING ACTION: A Best Practice Framework for the Management of Psychological Claims and its practical Action Area guides.

The Framework has been driven by life insurers and superannuation funds, with a sense that significant change was necessary.

“When we researched nationally and internationally for similar best practice Frameworks about managing disability claims there was little we could find, so this is a first,” says MetLife’s Claims Team Manager, Patrick Cowley.

 

A changing mindset for better outcomes

Putting the customer at the centre of the claims process has been a major driving factor in the development of the TAKING ACTION Framework. It is an important mindset change to be built in to every step of the claims process, and its best practice.

“The problem has been that claims are viewed in an insurance mindset,” says Dr Anne-Marie Feyer, project consultant and co-author of the Framework, of the similarities between the psychological claims process and that of a car or house insurance claim, for example. “That’s a very different thing to somebody’s health, and this Framework was about remembering that you’re talking about somebody who is already below par. You need to build that in everywhere.”

 

It speaks to all stakeholders

Whether you’re an insurer, superannuation fund, leader of a claims management team, employer or other stakeholder affected by psychological claims, the Framework is relevant to you.

“We’ve taken the opportunity to collate an evidence-based program that is all-inclusive, so all stakeholder groups see the same information,” Feyer says.

These different groups rarely have the chance to understand the process as a whole, from various perspectives, and so it was necessary for the TAKING ACTION Framework to break down those barriers.

“We’ve put everything into one space,” says Sue Bavcangiovski, Head of Claims, Group at TAL and member of the TAKING ACTION subcommittee, “and you can pick and choose the things that are relevant.”

The provision of such an innovative Framework will, in turn, incentivise the innovation of product design, which will be a focus of Action Area 6.

 

Making a difference based on evidence

The need for change is increasing rapidly, from macro, meso and micro angles:

  • The costs of mental illness to all industries is around $10.9 billion per year, and expected to grow to even greater rates. This is unsustainable
  • From an insurance perspective, mental health makes up 15 per cent of insurance claims, yet accounts for 50 per cent of the cost, showing vast room for improvement
  • From an individual point of view, change is necessary in terms of improving return to work and social outcomes and to create better claims experiences to facilitate these improvements.

The Framework pulls together an assortment of evidence, best practice strategies and innovations that will make a measurable difference at all levels and shows it really is time to DO BETTER (the acronym of our action areas). Action Area 3 will provide an outline of and measurement strategies for evidence-based interventions for Persons on Claim.

For more information about TAKING ACTION or to download the Framework and current Action Areas, please visit here.

If you’re a finance industry specialist who’s interested in joining the SuperFriend team to lead innovative projects like this, see a job opportunity here.